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General NPI Number Information
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NPI Number | 1548642838
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Entity Type | Organization
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Legal Business Name | MOBILE ENDOSCOPIX LLC
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 3330 DUNDEE RD STE C1
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City | NORTHBROOK
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State | IL
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Zip | 60062
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Country | US
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Telephone | 847-380-8992
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Fax | 847-562-0070
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Provider Business Mailing Address
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Address Line | 3330 DUNDEE RD STE C1
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City | NORTHBROOK
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State | IL
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Zip | 60062-2328
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Country | US
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Telephone | 847-380-8992
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Fax | 847-562-0070
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Authorized Official
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Title or Position | MANAGER
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Name | ELIZABETH C ROTH
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Credential |
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Telephone | 847-508-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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